The effect of orthodontic treatment on the periodontium and soft tissue esthetics in adult patients

Abstract

Objective Most patients seek orthodontic treatment to achieve an esthetic outcome. Orthodontic treatment has possible negative sequelae. The aim of this study is to assess these possible effects on the periodontium and tissue esthetics. Methods One hundred fifty‐six patients who have completed orthodontic treatment at Jordan University of Science and Technology clinics were recruited. They were divided into extraction and nonextraction subgroups. Another 155 patients never undergoing orthodontic treatment were assessed. The height of papilla, width of keratinized gingiva, gingival recession, degree of tooth display, smile line, crestal bone level, and proximal caries were assessed. Chi‐ square test was used for categorical/discrete variables while independent t‐test was used for continuous variables. The level of significance was set at (p ≤ 0.05). Results The mean age was 22 years with no significant difference between the groups. There was a significant difference between “ortho” and “nonortho” groups in tooth display and keratinized gingiva (p = 0.006 and <0.001, respectively). The overall crestal bone level, smile line, recession, and papilla fill did not show any significant differences (p = 0.200, 0.067, 0.120, and 0.066, respectively). The crestal bone level in the upper and lower anterior segments was significantly lower in the “ortho” treated group compared to the “nonortho” treated group (p = 0.002 and 0.005, respectively). A significant difference between “extraction” and “nonextraction” groups was in the width of keratinized gingiva (p = 0.003) and the number of teeth displayed (p < 0.001). Despite reaching statistical significance these differences are not necessarily of clinical significance. Conclusion Orthodontic treatment clearly affects the periodontal tissues; however, the detrimental effects appear to be minimal. Patients with history of orthodontic treatment might have lower crestal bone levels at certain sites and this should not be confused with periodontal disease.

Incidence of Gingival Black Triangles following Treatment with Fixed Orthodontic Appliance: A Systematic Review

“…At this step, 14 articles were nominated ( Figure 1 ) for full-text reading, which led to the exclusion of the other nine articles [ 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ], and the reasons for excluding these records are summarized in Table 1 . Finally, five articles [ 1 , 10 , 13 , 41 , 42 ] fulfilling the eligibility criteria were further analyzed for data extraction and answering the PEO question. The computed Cohen’s kappa values for inter-reviewer agreement for the title/abstract and full-text screening procedure were 0.83 and 0.89, respectively.…”

“…Amongst the included studies for the final analysis, three were retrospective cohort studies [ 10 , 41 , 42 ], one was a prospective clinical study [ 13 ], and one was a cross-sectional study [ 1 ]. The minimum number of patients included was 80 [ 13 ] while the maximum was 337 [ 42 ].…”

“…The classical reasons for seeking orthodontic treatment (OT) have changed over the last decades. Recently, individuals have sought OT to solve functional occlusal discrepancies as well as esthetic needs [ 1 ]. Until the early 1980s, patients were seeking OT mainly to correct malocclusion or restore normal occlusal function [ 2 ]; however, economic growth combined with changes in social norms have led to an increased focus on dental esthetic among adolescents and adults [ 3 ].…”

“…Until the early 1980s, patients were seeking OT mainly to correct malocclusion or restore normal occlusal function [ 2 ]; however, economic growth combined with changes in social norms have led to an increased focus on dental esthetic among adolescents and adults [ 3 ]. Considering patients’ esthetic needs, OT planning is more challenging for both orthodontists and periodontists; therefore, an interdisciplinary treatment plan is essential for managing associated periodontal issues before, during, and after OT [ 1 ].…”

“…Furthermore, a healthy periodontium can withstand tooth movements during OT without the deterioration of periodontal tissues [ 6 ]. On the contrary, OT may also have unwanted effects on periodontal tissues such as root resorption [ 7 ], bone dehiscence [ 8 ], loss of soft tissue architecture, gingival recession, and the formation of gingival black triangles (GBT), which may dramatically jeopardize the esthetic outcome [ 1 ]. GBT (also called “open gingival embrasure”) is formed due to the loss of interdental papilla [ 9 ].…”